| NPI | 1043759202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLINE VELASQUEZ Owner 231-487-2446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6801095890) |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2017-02-21 |